Duloxetine is contraindicated in patients with uncontrolled narrow-angle glaucoma due to the risk of precipitating an acute angle-closure glaucoma attack.
Contraindicated per FDA labeling for uncontrolled angle-closure glaucoma.
Risk is highest in acute or uncontrolled cases; controlled glaucoma may allow use with caution.
Screen patients for glaucoma history before prescribing.
Emergency symptoms warrant immediate ophthalmologic evaluation.
Duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), can cause mydriasis (pupil dilation) through its serotonergic and noradrenergic effects, which narrows the anterior chamber angle in susceptible eyes, leading to increased intraocular pressure (IOP).
Potential for acute angle-closure glaucoma, resulting in severe eye pain, blurred vision, headache, nausea, and permanent vision loss if untreated.
Avoid duloxetine in patients with uncontrolled narrow-angle glaucoma. Consider alternative antidepressants without anticholinergic or mydriatic effects. If necessary, ensure glaucoma is controlled (e.g., via laser iridotomy) before initiating therapy, and monitor IOP closely.
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